28th September, 2015
Recognition of the importance of nutrition and feeding practices will go a long was to prevent child mortality and the future of a nation
Oluremilekun Osobu-Asubiojo
The first two years of a child is not a period that should be toiled with. It contains the first 1000 days of a child begining from its journey through pregnacy. This is because it is a period that sets the future for the child, his health, well being and success in life. This period also encompasses breastfeeding, complementary feeding and transition from liquid food to solid food. It is a period where food habits are formed.
According to Ngozi Nnam, President, Nutrition Society Of Nigeria and Professor Of Community and Public Health Nutrition Department Of Home Science, Nutrition And Dietetics, University Of Nigeria, Nsukka, this first 1000 days of life is a critical window of opportunity to provide the child with adequate nutrition for proper growth and development, a period that ensures proper brain development, educational achievement, actualization of potentials and maximum productivity and national development.
“It is period which determines the outcome of pregnancy and the foundation for the child’s future life, a critical window of opportunity to provide the child with adequate nutrition for proper growth and development. To achieve this is by ensuring adequate nutrition during pregnancies which runs from zero to 280 days, exclusive breastfeeding from zero to six months and the onset of adequate complementary foods from six to 24 months with continuation of breastfeeding proces between 461 and 1000 days,” she said.
To her, it is a period that has direct impact and can change the future of families, communities and countries, break the cycle of poverty and intergenerational cycle of malnutrition.
It is for these same reasons that nutritional experts have advised mothers to take cognizance of what they consume before and during pregnancy as well as what a child consumes as the child grows up.
Photo: Remi Osobu-Asubiojo
Nnam educated that the first 1000 days of life remains a period of rapid growth when infants and children are especially vulnerable and at greater risk of malnutrition leading to stunting, wasting, underweight and micronutrient deficiencies. She stressed that the result of malnutrion as a result of deficiency of some micronutrients can cause diseases and common illnesses such as pneumonia, diarrhea and malaria due to a weak immune system which can possibly lead to death. To her, poor nutrition in the first 1000 days predisposes a child to chronic diseases in adulthood and sows the seed of chronic illnesses – diabetes, heart disease, obesity – which foundations are laid in the womb as some nutrients including protein, iron, folate, iodine, some fatty acids from fat and carbohydrates are needed for proper brain development. The first 1000 days helps in brain development determining how brainy and healthy a child would be for the rest of his or her life.
Experts reveal that up to 70 percent of brain development happens during pregnancy. While 15 percent develops during the first year of life. Nnam said that about 50 brain neurotransmitters are affected by the intake of nutrients in the first 1000 days. Inability to provide adequate nutrient for proper development of the brain leads to insult in the brain – reduces IQ by 13.5 points, even though the effect is irreversible. Inadequate supply of nutrients during the first 1000 days leads to stunted brain, stunted development which translates to stunted nation. “For these enormous direct impacts on the child, family and the nation she advised mothers to make positive sacrifices to ensure what they consume adequately contain all classes of food in right proportion in all stages of pregnancy to prevent mothers having to deal with the challenges due to malnutrition even when the child is born,” she added.
Malnutrition is the greatest cause of child death worldwide. In Nigeria, malnutrition is an underlying cause of more than 54 percent of child deaths. Nnam quoted a 2006 article in the Independent that outlined the findings of a United Nations report, “10 children die every minute as a result of malnutrition.”
Nutrition is the major intrauterine environmental factor that alters expression of the foetal genome and may have long term consequences – risk of developing various chronic non-communicable diseases including diabetes, cardiovascular diseases, obesity – later in life.
Gyneacologists and obstetricians have explained the importance of adequate nutrition throughout a woman’s life cycle from infancy, childhood to adulthood prior to pregnancy as it aids prevention stunted growth, small pelvis, obstructed labour, low birth weight babies and possible death of foetus. Adequate intake of proteins, vitamins, iron, zinc, iodine,folic acid , calcium and minerals prior to pregnancy and between pregnancies, that is from 0 to 280 days help to meet the rapid increase in cell number and development of the zygote.
It has be proven that deficiencies of some micronutrients like folate and iodine affect the foetus shortly after conception. Nnam mentioned that with obvious reasons to nuture a new being in the womb, there must be increased nutrient supply for pregnant women relative to that of non-pregnant women with adequate energy supply of 2200kcal + 452 kcal about 21 percent increase, Protein 46g + 25g about 54 percent increase, Vitamin A 700RAE +70RAE about 10 percent increase, iron 18mg + 9mg about 50 percent increase, folate 400μg + 200 μg which is about 50 percent increase, Iodine 150 μg + 70 μg , 46.6 percent increase and Zinc 8 mg + 3 mg which is also about 37.5 percent increase till delivery, after which the onset of exclusive breastfeeding is established from 0 to six months, that is from 281 to 460 days.
Also, dieticians have proven that breast milk is nature’s perfect food for babies. The nutrient composition is adequate in quantity and quality to meet the nutritional needs of the infant and sustain the rapid growth and development of the baby. Breast milk contains anti-infective factors, which protect the baby against infection.
Breastfeeding is a natural way of providing young infants with the nutrients they need for healthy growth and development. The nutrient composition of breast milk is approximately: fat-3.80 percent , protein- 1.20 percent, lactose- 7.00 percent, ash- 0.21 percent, water-87.60 percent.
The water content of breast milk is of reasonable quantity, which does not necessarily require further intake or provision of water from other sources for infants. The belief that the baby needs water to aid its digestion is an act that is often misunderstood by many mothers in the society.
To ensure an infant gets the best nutrients and satisfaction from breast milk, experts have advised proper positioning of babies to the breasts to make sure that the mouth is well placed on the nipple and the brown area surrounding the nipple by allowing the baby to suck enough on one breast to assess the hind milk which is concentrated before putting him on the other breast.
Mothers are advise to start breastfeeding within the first 30 minutes after birth to allow the baby take colostrum- the yellow and thick milk secreted for the first few days after delivery.
Colostrum contains more antibodies and white blood cells than later milk. It gives the baby the first immunization against bacteria and virus.
To guarantee babies have adequate breast milk, mothers can maintain a supply by expressing milk, which can be fed from a cup during their absence. Expressed breast milk is safe for up to eight hours at room temperature. If refrigerated, it may be safe for up to 24 hours.
Almost all mothers can participate in this exercise, provided they have accurate information and support of the family. An HIV-infected mother can also participate in it since it has been discovered that though an HIV-infected mother can pass the infection to her infant during delivery and through breastfeeding, antiretroviral drugs have come to the rescue to avail the children of HIV-infected mothers the great benefits of breastfeeding. Mothers should be on nutritionally adequate diet to facilitate breast milk production.
The world Health Organisation, WHO, reveals that about 800, 000 children would be saved from childhood mortality if they are breastfed exclusively for six months with subsequently breastfeeding process in addition to complementary foods for two years. Complementary foods are the foods given to babies in addition to breast milk at the completion of six months to fill the gap between the total nutritional needs of the child and the amounts provided by breast milk.
Mothers are advise to start with porridge made from any of the local staples – rice, maize, millet, sorghum, yam, potatoes, plantain. The staple is milled to flour and cooked to make porridge. Mothers are also to ensure that the porridge is thick enough to stay easily on the spoon. Thin porridges that could be fed from a feeding bottle, or drunk from a cup should be discouraged.
Drawing attention to the importance of breastfeeding for infants, WHO adopted a mission of an international code for breast milk in 1981. This code also has to do with regulation of breast milk substitutes that calls for all formula labels to be inscribed with information to state the benefits of breastfeeding and the health risks of substitutes on their products.
This is evidently proven on many baby formula imported or produced locally made in Nigeria. Dieticians also advise mothers to include fruits and vegetables in their meals to supply the micronutrient needs of the baby as small amounts can meet some or all of a child’s daily requirements of vitamins.